Formulary #4Formulary #3Formulary 2Medications Available For Patients who need to pay by cash. Home PageFormulary #6
  Formulary pg5  
 
 
  

Diabetes Medications

  
P0100030   Glipizide (Glucotrol) 5mg Tablets #30  $Call
P0100060   Glipizide (Glucotrol) 5mg Tablets #60            $Call
P0099030   Glipizide (Glucotrol) 10mg Tablets #30  $Call
P0381030   Glucovance 5mg Tablets #30  $Call
P0103030   Glyburide (Micronase) 5mg Tablets #30            $Call
    Glyburide Metform 1.25/250 (Glucovance) Tablets #30 $Call
    Glyburide Metform 2.5/500 (Glucovance) Tablets #30 $Call
    Glyburide Metform 5/500 (Glucovance) Tablets #30 $Call
O0000088   Humulin 70/30 U Insulin Injection 10ml Vl  $Call
O0000089   Humulin N 100 U Insulin Injection 10ml v  $Call
O0000090   Humulin R 100 U Insulin Injection 10ml vl  $Call
O0000109   Insulin Syringe 1/2cc w/ 28 x 1/2 needle   100/box  $Call
P0493030   Metformin (Glucophage) 500mg Tablets #30  $Call
P0493060   Metformin (Glucophage) 500mg Tablets #60  $Call
P0497030   Metformin (Glucophage) 850mg Tablets #30  $Call

Eye and Ear Medications

  
R0235015   Auroto (Auralgan) Otic Solution 15ml  $Call
R0258015   Ear Wax (Debrox) Drops 15ml  $Call
R0261305   Erythromycin Opth Opth Oint 3.5gm  $Call
R0270005   Gentamicin (Garamycin) 0.3% Opth Solution 5ml  $Call
R0302015   Naphazoline  (Naphcon) 0.1% Opth Solution 15ml  $Call
R0303005   Neo/Poly/Dex (Maxitroll) Opth Susp 5ml            $Call
O0000152   Neo-Poly-Hc (Cortisporin) Otic Solution 10ml  $Call
O0000153   Neo-Poly-Hc (Cortisporin) Otic Susp 10ml  $Call
R0578015   Poly/Trimeth/Sulf (Polytrim) Opth Solution 10ml  $Call
R0337015   Sulfacetamide Sodium (Sulamyd) 10% Opth Solution 15ml  $Call
R0336305   Sulfacetamide Sodium (Sulamyd) 10% Opth Oint 3.5gm  $Call
R0338005   Sulfacetamide Sod-Pred (Blephamide) Opth Solution 5ml  $Call
R0343005   Tobramycin 0.3% (Tobrex) Opth Solution 5ml  $Call

Gastrointestinal Medications

  
R0227012   Anucort-HC (Proctocort) 25mg Supp's 12/Box  $Call
R0241004   Belladonna Alk/Phen (Donnatal) Elixir 4oz  $Call
P0032030   Belladonna Alk/Phen (Donnatal) Tablets #30  $Call
P0517060   Bisacodyl 5mg Tablets #60  $Call
R0544150   Calcium Carb (Antacid) 500mg Chewtabs #150  $Call
P0687180   Calcium Carb (Antacid) 500mg w/Vit D Tablets #180  $Call
P0057030   Cimetidine (Tagamet) 400mg Tablets #30            $Call
P0057060   Cimetidine (Tagamet) 400mg Tablets #60  $Call
P0291030   Dicyclomine (Bentyl) 10mg Tablets #30  $Call
P0074030   Dicyclomine  (Bentyl) 20mg Tablets #30  $Call
P0082020   Diphenoxylate/Atropine (Lomotil) Tablets #20  $Call
P0083030   Docusate Sod (Colace) 100mg Capsules #30  $  Call
P0083180   Docusate Sod (Colace) 100mg Capsules #180  $Call
P0543030   Famotidine (Pepcid) 20mg Tablets #30  $Call
R0624015   Hyoscyam .125mg (Levsin) Drops 15ml  $Call
R0490012   Kaopectolin (Kaopectate) Liquid 12oz  $Call
P0132012   Loperamide (Imodium) 2mg Capsules #12  $Call
P0670002   Mebendazole (Vermox) 100mg Chew Tab #2  $Call
P0286030   Metoclopramide (Reglan) 10mg Tablets #30  $Call
R0297012   Mi Acid-II (Mylanta II) Liquid Susp 12oz  $Call
P0642030   Oxybutynin (Ditropan) 5mg Tablets #30  $Call
O0000168   Pink Bismuth (Pepto Bismol) Chew Tablets #30  $Call
R0332013   Psyllium (Metamucil) Powder 13oz  $Call
P0188030